Tag Archives: human rights

In the last 72 (or so) hours I’ve had six conversations about privilege. Each time I’ve been annoyed that whichever academic articulated the truth that attributes over which we have little or no control play a significant role in how we are perceived and how much (or little) we have to overcome didn’t choose a more palatable word to describe it.

Here are some of my privileges:

• I’m white, in a country and a dominant culture that prize caucasoid heritage and appearance

• I have been able-bodied for all but a small percentage of my life

• my parents were married and lived together throughout my childhood and adolescence

• my father was employed the entire time I was dependent on him

• I grew up never knowing food scarcity, and never worrying about a roof over my head

• my parents prized education, and read to me from birth

• I am intelligent and literate

• I am cis-gender

• I am middle-class and well-spoken

• I did not grow up at risk of or exposed to crime or illicit drugs

These privileges, which I had no input into and cannot take credit for, do not mean my life has been a cake walk, or that I haven’t worked hard for where I am now. They do mean that I had, and have, things easier that someone else who, all other things being equal, didn’t have those unearned advantages.

Acknowledging my privilege doesn’t mean denying or ignoring aspects of myself or my life that were disadvantageous. I experienced abuse; was raised by an alcoholic and a narcissist; spent much of my teens, all of my twenties, and some of my thirties with an eating disorder that’s now in remission; I am female, fat, and queer in a country and a culture that repudiates these to various degrees.

These and other aspects of who I am and what I’ve experienced don’t cancel out my privilege.

We live in a society that prioritises straight, white, cis, able-bodied, wealthy men. The more closely one fits that ideal, the more credit one is given – to be more readily heard, believed, perceived as honest/intelligent/promotable; the further away one is, the more likely one is to be ignored, mistrusted, arrested, convicted, attacked.

This doesn’t mean every straight, white, cis, able-bodied man has been handed life on a plate, has experienced no hardship, or lives a life of luxury.

It means that being aware of fortune makes us more compassionate. Noticing the distance we have to travel compared to those with less congenital luck makes us more likely to extend a hand to those with further journeys. Seeing systemic injustice makes us work to level out what we can, to increase fairness, equity, the proverbial fair go Australia prides itself on.

One of the objections about assisted dying legislation is that vulnerable people will die, through coercion, because they feel like a burden on their families, for financial gain, or because their care is expensive or onerous. These are valid concerns to have – we know that there are unscrupulous people who take advantage of even their own relatives, that not all health practitioners are wholly ethical, and that there are financial pressures on health facilities at every level. And many of us have heard reports from overseas about people who didn’t meet the criteria being killed under the auspices of assisted dying laws, or weren’t reported to the government. While on closer examination these reports invariably turn out to be distortions or unsubstantiated allegations, a topic I may address at another time, the fear they address is a reasonable one – even if they haven’t happened, they could.

Last week, when I briefly summarised the final report of the voluntary assisted dying expert advisory panel, I mentioned some of the 68 safeguards that are in place. Today I’ll go into detail about the requirements and regulations that will be implemented to prevent this legislation being misused.

The first six safeguards ensure that requesters meet all of these threshold requirements before the process starts. They must:
• be eighteen or older (this law will not apply to minors),
• be resident in Victoria (people can’t travel here to die with assistance),
• be competent to make significant medical decisions (using the same standard the Medical Treatment Act, 2016, requires),
• have a life-limiting condition, illness, or disease (e.g. metastatic cancer, end-stage heart failure, motor neurone disease),
• have a prognosis of twelve months or less (their death is inevitable, and not distant), and
• be ‘experiencing enduring and unbearable suffering that cannot be relieved in a manner the person deems tolerable’ (e.g. for that person it may not be acceptable that the only analgesic dose sufficient to make their pain bearable makes them unconscious),

Note that a person must meet all of these criteria before the process of assessment can begin; in contrast, in the US people do not need to be suffering, while in Europe it isn’t required that they be dying.

The legislation specifically notes that disabilities and mental ill-health are neither barriers to, nor reasons for, voluntary assisted dying. In other words, someone may not access assisted dying because they have, for example, significant cerebral palsy, or are paraplegic, or have clinical depression, or schizophrenia – the requirements for a life-limiting illness, condition, or disease, a terminal prognosis of under a year, and enduring suffering, apply universally. Conversely, people who meet all the other criteria cannot be deemed ineligible because of a physical disability or mental ill-health.

The rest of the safeguards are divided into areas of protection. First are measures to ensure that the request process is voluntary:
• health practitioners are prohibited from bringing up the option of assisted dying with their patients – it must come from them,
• nobody except the person can request on their behalf, even someone with medical power of attorney and an advanced directive demonstrating that this is what they want,
• there must be three requests, over at least ten days, one of which must be written, and witnessed by an independent person, and
• the person can change their mind at any time, including after the prescription has been filled.

Next is the process of assessment, which is clearly and tightly described:
• two independent, experienced medical practitioners must separately assess the person (overseas this typically takes 60-90 minutes per consultation),
• only doctors who have undertaken specialized VAD training may be involved,
• the two assessing doctors are designated the coordinating practitioner and the consulting practitioner, each with well-defined duties, and
• either doctor may, and is obliged to, refer the patient to a mental health professional if they have concerns about the person’s decision-making capacity,

There have been concerns about prescribed medication going missing or being taken accidentally. To that end, the following measures will be introduced:
• the prescribing doctor must have a specific permit,
• the patient must nominate a contact person who agrees to take responsibility for returning the medication to the dispensing pharmacist if it is unused,
• from the time it is dispensed until it is taken or returned, the clearly labelled medication must be stored in a locked box,
• if the patient is unable to self-administer (e.g. is unable to swallow, has restricted arm movement), the coordinating doctor (and only the coordinating doctor) may administer the medication, and
• in that case the doctor must have additional certification, and the administration must be witnessed by someone who is independent of the doctor.

Unsurprisingly, health professionals, particularly doctors and nurses, have concerns about their roles, from being forced to perform acts with which they object, to being prosecuted. To protect them,
• health practitioners may conscientiously object to participating,
• there are protections for health practitioners who are present at the time of administration, and
• health practitioners will be required to report any practitioner acting outside the legislation.

There was a question raised about criminal consequences for health professionals who act outside the scope of the legislation – initiating a discussion about the option of assisted dying, for example. That is not specifically addressed, as there are already consequences for health practitioners who break the law or otherwise act in breach of the standards of each registered profession (one of which includes following the law), and charges of manslaughter and murder are not affected by the introduction of voluntary assisted dying legislation – it is still a crime to aid or to abet a suicide, or bring about someone’s death, except for the carefully delineated circumstances surrounding this Act. There will, however, be new laws introduced: failing to report any step, inducing or influencing a person to request or participate in assisted dying, and falsifying reports to the oversight and review panel will be criminal offences.

Finally, there have been allegations that not all deaths overseas that take place under the auspices of an assisted dying framework are reported or investigated appropriately. In Victoria, part of the process includes the creation of an independent multidisciplinary oversight and review panel. They are notified at every step of the process, from the first formal request to notification of death. Included in this process is notification whenever a prescription written to assist dying is filled. The patient’s contact person is tasked with returning the medication when the patient dies, if it was not used; if they fail to do so, the panel is empowered to follow up with them about the location of the medication, and ensure it is safely accounted for.

The oversight and review panel’s role will be enshrined in legislation, and it will have the capacity to refer breaches of the legislation to the appropriate authorities, from the health regulator AHPRA to the police. The panel will review every case, transparently report publicly, and publish a review after five years.

The expert advisory panel estimates that it will take eighteen months to set up all of the required safeguards (e.g. medical education) and legislative changes, before the first requests can be made.

But first the Bill has to get through both Houses of parliament. Which is where you can come in: if you support the legislation and you live in Victoria, please contact your lower and upper house MP’s to let them know – they can’t represent their constituents if they don’t know what you want.

Over the next couple of weeks I’ll explore some aspects of this comprehensive, 257 page report in greater detail, including one post dedicated to detailing and discussing the 68 safeguards it recommends. Today, though, I’ll just cover the highlights of the final report from an expert committee that comprised representatives from medicine, nursing, health care institutions, the law, disability advocacy, and palliative care.

The biggest take away message is that this will be the most rigid assisted dying legislation passed anywhere, taking all the requirements, oversights, and safeguards used around the world, then adding more.

To start, applicants must meet all of the following requirements:

be aged 18 or over

be resident in Victoria

be competent to make complex medical decisions*

be diagnosed with a terminal/life-limiting illness, disease, or condition

have a prognosis of twelve months or less, and

have suffering that is not able to be relieved

Each element is detailed, from who can initiate discussions about assisted dying (only the patient) to the requirements of the two assessing doctors (one of whom must be qualified in the relevant specialty [e.g. oncology, if the person has metastatic cancer], one of whom must have at least five years’ post Fellowship experience, and both of whom must be fellows of a college, and both must have completed the required VAD training); from the timing and sequences of steps (three separate requests, on in writing, over a period of not less than ten days**) to when a person can change their mind (any time in the process up to and including the point of swallowing the medication); safe keeping of the medication, from a designated contact person who must return dispensed medication if not used, to storage of the drug in a locked box; and oversight, from tracking presented prescriptions to review of all cases by an expert panel, who are reported to at each step of the way.

There are safeguards to ensure that unscrupulous relatives aren’t taking advantage of a vulnerable relative, with requirements both regarding competency (as mentioned earlier), and that witnesses to the person’s written request may not benefit from the person’s death. Similarly, in the event that physician-assistance is required (in rare case where the person either cannot physically pour, hold, and swallow the medication, or lacks the digestive process to safely swallow and absorb the usual oral preparation), there must be a witness independent from the assisting physician, to attest that the patient was willing right to the end.

The most significant aspect, consistent throughout, is that participating is voluntary for every person, at every stage. The requests must be made by the dying person; the assessing doctors have the right to conscientiously object; the nominated contact person must agree to taking responsibility for the medication and other obligations; nurses can choose to conscientiously object to involvement in education or facilitation of the assisted dying; and in the event that the patient needs physician assistance because they are unable to take the medication (either because of physical or digestive incapacity), the coordinating doctor must consent, along with the witness.

This is a rigorous, restrictive, robust document that provides consistent, thorough safeguards, strong review processes, and (in combination with registration requirements from the boards overseeing health professionals) penalties for breaches from and non-compliance with the regulations. Now we just need to get it passed.

* “The Panel considers that the four part decision-making capacity test in the Medical Treatment Planning and Decisions Act should be used to assess an adult’s decision-making capacity in relation to voluntary assisted dying. The Act is contemporary, having been passed in 2016, and is generally regarded as a appropriate to test decision-making capacity for a wide range of medical treatment decisions.” Ministerial Advisory Panel on Voluntary Assisted Dying Final Report, 2017 p. 60

** except in exceptional circumstances, when the person is highly likely to die within the usual waiting period

In 2013 I marched, for the first time, under the banner of my union, in Melbourne’s annual Pride march, honouring and celebrating lesbian, gay, bisexual, transgender, transsexual, intersex and asexual (LGBTQIA) members of our communities. I marched for my patients, colleagues, friends, and lovers who belong to these communities, and for those whose friends and families don’t or won’t support them.

I found marching a unifying, affirming act, and a public declaration of something I hold dear – the ongoing fight by unions for the rights and equity of marginalised groups: the right to be treated fairly, without bias or discrimination, without stigma or prejudice. That’s core union business, as much as fighting for women, for migrants, for 457-visa holders to have equal pay, rights and access.

And, I must confess, I found it gratifying to hear calls of “Here come the nurses!” “And midwives!” accompanied by cheers. It also felt good to be marching for something, in celebration, rather than against yet another attack on wages, conditions, or on those of us with least.

So it was with considerable regret that, for family reasons, I had to be overseas during Pride, both last year and this. I thought of Pride when Sunday morning (AEST) rolled around, marching in spirit though my body was in Colorado. And I visited the ANMF (Vic branch)’s Facebook page to see their post about this year’s march.

I was a little disappointed to find, among the positive comments, a couple of posts from people who felt that
● “no workplace union should be out there marching for moral issues”
● this kind of celebration is “a bit difficult, it’s all a bit Daffyd The Only Gay In The Village, look at me look at me”.
● “perhaps members should be consulted” before staff and members marched under the union banner, because “this is still a very controversial issue”,
● “gay rights etc is not a work related issue as such,”
● “Are we going to march for every single minority out there??? Either we march for all or none” and
● we have higher priorities than supporting Pride, particularly “access to health services”

This post is not at all intended to attack people who feel this way; that’s not helpful. Instead I’m writing this post to address the issues raised by these commenters – I don’t know if they’re members, but I’m certain there are members of our union who have similar positions. As I read it these concerns come down to:
1. there is something controversial about LGTQIA rights, or campaigning for them, or about LGBTQIA people
2. members should be consulted before ANMF endorses, supports or champions something controversial
3. union business is about work related issues, and ‘gay rights’ aren’t work place concerns
4. LGBTQIA people are a minority, and if we support one minority group we should support them all
5. there are more important things to fight for

First of all, I agree (as one of them went on to say) that “Gays should be accepted as just normal people with a different sexual preference, not as a race apart” though I’d word the sentiment differently. Unfortunately, though, that’s not yet where we are, and until sexual orientation and gender identity are treated as neutrally as eye colour or arm length, there’s work to be done. I’d like to take you through some of the other concerns that were raised.

Controversy and morality
It’s true that there is controversy in some segments of Australia about any kind of ‘lifestyle’ that isn’t heteronormative (one man and one woman, in a monogamous, preferrably married, relationship) and cisgendered (people whose identity, body, and gender assigned at birth are all the same). It’s hard to know from what was posted which aspects of LGBTQIA people the commentators have an issue with – I suspect, from discussions I’ve had previously about this, that there are a few, wrapped up together.

The first is that LGBTQIA people have wilfully chosen their orientation and/or identity to be difficult, controversial or subversive. To which I say: talk to the very many survivors who spent in some cases decades hating themselves, harming themselves, and planning suicide because of truths about their core identitites that they couldn’t change, however hard they tried. One of my friends sent me his story yesterday – for years the fear of being rejected by his family and the small town he grew up in cast such a deep shadow over his life that he was so deeply depressed he planned a one way trip, the only way Al could see to escape his “pain and torment.” It was chance and wonderous good luck that he was shown another path, to realisation of his potential, a man “full of fight and compassion and living a life of service, supporting and caring for others.” This is a reality for many people, especially young people, who feel different from the mainstream, and it’s not about who they are, it’s about not being accepted by those who should most love them.

The second, as illustrated by the Daffyd comment, is that marches like Pride are showboaty, prideful, and unnecessary. ‘Why,”some people wonder, ‘can’t they just get on with life like the rest of us?’ I would say for three reasons – the first is that, after years of hiding who you are, concealing key parts of who you are from family, friends, colleagues, community, there is joyous liberation in being able to say who you are, aloud, in public, and have it be celebrated. The second is to show young people, like my friend, who feel as though they’re alone, that there’s a wider world out there – that there are alternatives to spending your life pretending to be someone you’re not until the pain of hiding who you are is greater than the pain of claiming it, or ending the pain. And marches give people and organisations who support diversity, and the rights of all of us to live lives as full and productive as possible, to show that there are people and groups who’ll embrace them for who they are, without judgement.

The third is because they believe marriage ought to be reserved for straight couples (in some versions this is justified as being about rearing children). There is not space here to discuss this argument, as my response would double the length of this not short piece. What I’ll say instead is that the most recent survey of Australians’ positions of marriage equality shows 72%, or just under three-quarters of all Australians, support marriage equality.

Regardless of how one views the question of the morality of non-heteronormative, cis-gendered people, it’s true there’s still some controversy. Of course, I can’t think of anything that isn’t controversial – medical marijuana, asylum seekers, vaccinations, funding public health care, climate change – and for some of them debate will continue without resolution, however long we talk and whatever evidence comes in. ANMF (Vic) also has positions on all of these, any way. If we waited we’d never act on anything.

Consultation with members
ANMF (Vic) is a union, designed to act on behalf of its members – if we don’t, we’re no longer functioning as a representative body. We’re fortunate to be a very large union, with over 71,000 members at the time of writing, and individual consultation isn’t possible, so we have substitutes – work place representatives, who may choose to attend an annual delegates meeting, and elected officials. In addition, any member may make a submission to the union, directly, through their job rep, or through an organiser.

Last year, for example, I suggested we support the campaign to legalise medical marijuana – it’s a health issue, so if affects our patients, and it’s currently an industrial issue, as some members have become ensnared between the law and parents administering marijuana oil to hospitalised children, so it falls into our purview on two counts. And it’s controversial, because the majority of evidence is annecdotal, and it involves a drug that’s surrently illegal, which is why an email was sent to members asking for their response – fewer than 1,000 members replied, overwhelmingly positively, and so we’ve added our voice.

In 2012, at the Victorian branch’s annual delegates meeting, a motion was put that ANMF (Vic) support the campaign for marriage equality. The delegates present voted overwhelmingly in support the campaign for marriage equality. The members who moved, seconded, spoke to and voted for the motion are representatives of their workplace members. On this, the question of supporting equal rights for LGTQIA people, the members have already spoken.

What constitutes union business
Unions are about collective bargaining, improving work conditions (eg OH&S, pay and benefits, career structure), and equity, so supporting populations who are discriminated against is very much union business. Much of the progress made in work place gender equality, including equal pay and paid maternity leave, has come from the work of unions.

Perhaps, more than anything else, unions are about solidarity – about us being stronger together than we are separately, that united we have power and apacity to make change that doesn’t exist if we act alone. A key part of union solidarity is that we stand up for those who need their voices amplified. That’s why, at the last members meeting of our 2011/12 EBA campaign, Lisa Fitzpatrick told us about the NUW strike at Sigma Pharmaceuticals in Rowvill, and why some of us went along to support blue collar men and women whose work is nothing like ours, and whose fight was the same.

If we cared, and fought, only for those issues that we were directly affected by, there wouldn’t be a union movement – and so much of what we take for granted, the rights we have every day, wouldn’t exist. Why would men care about women being able to work after they were married? Or maternity leave provisions? Why would teachers care about deaths on construction sites? Why would Australian workers fight for the rights of workers in Sri Lanka? [link: http://www.sigtur.com/latest-stories/union-protest-embarrasses-ansell.html – photo, if we have one?]

Solidarity is why ANMF (Vic) staff and members marched alongside teachers, fire fighters, paramedics; why we’ve marched for asylum seekers, World Peace day, marriage equality, secure work, maintaining funding for WorkCover, and for Medicare funding. Because all of these things matter, and we are part of all of them – as my friend Benjamin says: “Solidarity means you march and support those groups who are still in many ways at the bottom of the pile socially, ecomomically, culturally and politically.”

However, even if that were not the case, this is also a health issue – stigma, persecution and discrimination are strong contributors to the high rate of depression, anxiety, suicidality and substance abuse among people who are LGBTQIA, and that makes it very much an ANMF issue. As does the fact that our members include lesbian, gay, bisexual, transgender, transsexual, queer, intersex and asexual nurses, midwives, patient attendants and students. Participating in this march shows people that it’s okay to acknowledge who you are, that you’re not alone (however much it may feel otherwise), and that you’re supported and accepted by the wider community.

And that, I hope, also addresses the question about whether we’re going to support other (or all) minority groups – if they’re discriminated against, if they have access to fewer rights, lesser conditions, then yes, we will.

What we should fight for

Late last year Victorian Trades Hall hosted a film night to thank volunteers involved in the election campaign. The film screened was Pride – it tells the true story of how a small group of London lesbian and gay men decided to support the 1984 Welsh miners’ strike:

It is a brilliant film that illustrates far more eloquently, ably and upliftingly than I just how LGBTQIA rights and union fights intersect, though the miners’ union took a year to come around to that position. Indeed, the fit is so natural, so apparently self-evident, that I was genuinely shocked it took until only thirty years ago to be embraced in the UK.

In Australia, though, some of us got there a little sooner – in 1973, five years before the first Sydney mardi gras, and 11 years before the events recounted in Pride, members of the Builders Labourers Federation working onsite at Macquarie University went on strike in support of a gay student activist who was excluded from the university because of his refusal to repress his orientation and “seek help.” I wrote about solidarity – it’s a core union value, and always has been.

It’s hard to think of many groups less likely to support a gay tertiary student than early seventies construction workers, but “It’s the principle of the thing. They shouldn’t pick on a bloke because of his sexuality.” – Bob Pringle, then-BLF President (NSW branch). Read more here) And they went out again, the next year, when Penny Short’s scholarship was withdrawn because being a lesbian made her “medically unfit.”

There are higher priorities
Finally, the concern was posted that LGBTQIA rights are outweighed by other, more direct concerns facing nurses and midwives, including cuts to health care funding, inadequated aged care services, and poorly served rural and remote communities. And it’s true that there is an increasing demand for health care services, and Mr Abbott’s attacks on Medicare certainly warrant a strong and decisive defence.

I won’t ask if the person who posted this comment fought against the privatisation of Victoria’s public aged care beds, or has campaigned to save Medicare, though I’d like to note that I have, and I’ve been proud to stand shoulder to shoulder with my union’s executive and staff while doing so. Instead I’ll point out these two things. First, like sexuality, this isn’t a binary state – we can champion more than one injustice or cause at a time. Indeed, we must – if we only focused on one issue, however worthy, we would have trouble achieving anything. And for the second I will once again cite Benjamin:Being part of any group larger than just ourselves means there will be things we don’t completely agree with – compromises for an overall win, fighting on behalf of people who are happy to reap the rewards of a campaign without participating, or agreeing to step back on one point for an intact and united front. Nobody is asking anyone else to participate in, or to personally endorse, anything they don’t agree with, and though I am a member, a long-time job rep, and a new branch councillor, I don’t speak for ANMF – in this piece, on my blog, to the media or on social media.

That said, I know I speak for ANMF (Vic) branch, for ANMF federally, and for the union movement as a whole when I say – lesbian, gay, bisexual, transgender, transsexual, queer, intersex and asexual rights are human rights, and they are most definitely a union fight, a health issue, and ANMF business.

Note: I am indebted to those friends who responded to my request for comments as I was writing this, including my anonymous friend for allowing me to use his story, Benjamin for drawing my attention to the case of Jeremy Fisher and for permission to use his words, and to Julie Wearing-Smith for both her support and for encouraging me to expand a Facebook response into a rather lengthy essay. And while I’m at it, thank you to my wonderful union.